Important

Your login session will expire in seconds

Would you like to extend your session?

Jackson Logo
Questions? Call us toll-free
(877) 565-2968

    Forms

    Please reference the contract number on each page of all forms and any accompanying correspondence. A newly completed form is required for all requests. Forms that have been reused will not be honored.

    Jackson recognizes that information security is critical to maintaining the trust of our customers and advisors. To protect customer data, some forms may be accessed only after logging into our website. Click the "Sign In" button at the top right of this page to get started.

    Sign In To Pre-Filled Forms

    Sign in to pre-fill the contract number and owner name.

    Note: Not available for all forms

    Upload Scanned Form

    Download and complete the electronic form you intend to submit, and then sign in here to upload it.

    Start A Claim

    Start your claim online. On average, it takes 5 to 10 minutes.

    START A CLAIM

    Search

    Filter By:

    Form Search Results

    Select All
    		NameDescriptionTransaction TypeForm NumberStates
    		Accelerated Benefit Claim Complete to file an accelerated benefit claim. Claims NZ1361 10/22 NY
    		Accelerated Benefit Claim Complete to file an accelerated benefit claim. Claims Z1361 12/23 AK, AL, AR, AZ, CA…
    AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
    		A Consumer's Guide to MIB's Underwriting Services Describes MIB and explains consumer's rights to receive a copy of their record Life Insurance Policy Changes XADV9055 10/22 AK, AL, AR, AZ, CA…
    AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
    		Activation of Lifetime Income Benefit Request Use this form to activate a Lifetime Income Benefit. Other Transactions X4391 06/20 AK, AL, AR, AZ, CA…
    AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
    		Add-On Benefit Election/Termination Guaranteed Minimum Withdrawal Benefit and Guaranteed Minimum Accumulation Benefit Use this form to add or terminate a GMWB or add a GMAB. Other Transactions V4390 10/24 AK, AL, AR, AZ, CA…
    AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
    		Add-On Benefit Election/Termination Lifetime Income Rider/Lifetime Income Benefit Use this form to add or terminate a Lifetime Income Rider or Lifetime Income Benefit. Other Transactions X4390 12/23 AK, AL, AR, AZ, CA…
    AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
    		Add-On Benefit Election Guaranteed Minimum Withdrawal Benefit Use this form to add a GMWB. Other Transactions NV4390 10/24 NY
    		Affidavit of LOST POLICY Use this form when a policy/contract is lost. Other Transactions X2028 01/21 AK, AL, AR, AZ, CA…
    AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
    		Affidavit of lost Policy/Contract Use this form when a policy/contract is lost. Other Transactions N2028 04/24 NY
    		Annuity Direct Deposit Request Use to set up or change bank information for direct deposit into client's bank account. Payments & Deposits, Withdrawal X1091 01/21 AK, AL, AR, AZ, CA…
    AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
    Email Blank Form
    Protected Form

    Annuities are issued by Jackson National Life Insurance Company (Home Office: Lansing, Michigan) and in New York, annuities are issued by Jackson National Life Insurance Company of New York (Home Office: Purchase, New York). Variable products are distributed by Jackson National Life Distributors LLC. May not be available in all states and state variations may apply. These products have limitations and restrictions. Contact the Company for more information. Jackson is the marketing name for Jackson Financial Inc., Jackson National Life Insurance Company and Jackson National Life Insurance Company of New York.

    Broker Check by FINRA

    Not FDIC/NCUA insured • Not bank/CU guaranteed • May lose value • Not a deposit • Not insured by any federal agency

    Jackson works with vendors and other partners to help deliver online and mobile advertisements for Jackson that we think may be of interest to you. For more information about how we utilize cookies and vendors to deliver online advertising, please see our Web Site Privacy Practices. If you wish to opt-out of this type of advertising visit Do Not Share My Personal Information.

    CMC17302 06/25

    Jackson National Life Insurance Company
    1 Corporate Way
    Lansing, MI 48951